~(103)Pd支架预防血管成形术后再狭窄的实验研究

目的　探讨1 0 3 Pd支架对血管成形术后再狭窄的预防作用。方法　对雄性新西兰白兔进行腹主动脉球囊拉伤后置入1 0 3 Pd支架和普通支架 ,各 2 5只实验兔。 2组分别于术后 3d、1、2、4和8周分批用γ计数器进行血管组织和静脉血放射性测定、免疫组织化学测定、组织病理学和血管造影检查。结果　拉伤后 8周造影显示 ,1 0 3Pd支架组血管最小内径显著大于普通支架组 (P <0 0 1) ,血管狭窄程度明显减低 (P <0 0 5 ) ;各亚组间静脉血的放射性无差异 ;2组支架周围组织放射性无统计学差异。结论　1 0 3 Pd支架较普通支架可以显著减少血管成形术后再狭窄的形成 ,1 0 3Pd作为放射源安全和有效     

血管内支架置入治疗高危颈动脉狭窄

目的　评价伴对侧颈内动脉闭塞的高危颈内动脉狭窄病人血管内支架治疗的疗效和安全性。方法　 8例不适合颈动脉内膜剥脱的高危颈内动脉狭窄病人接受了血管内支架置入治疗。术前颈内动脉平均狭窄程度为 (85 2± 9 4) % (70 %～ 98% )。术前和术后 2 4h采用NIHSS评分 ,术前和术后 3个月采用改良Rakin评分标准对这些病人进行神经功能评分。术后随访 6～ 1 4个月。结果　术中造影证实 8枚支架均放置成功 ,残余狭窄程度 (5 3± 2 2 ) % (5 %～ 9% ) ,管腔狭窄程度较术前明显改善 (t=4 79,P <0 0 0 1 )。术中没有发生与手术相关的并发症 ,术后 2 4h病人的NIHSS神经功能评分保持在术前水平 [(2 5± 2 4)分 ] ;术后 3个月 ,改良Rakin神经功能评分为 (1 1 3± 0 99)分 ,同术前 (1 2 5± 1 2 8)分比较差异无显著性意义 (T =1 89,P >0 0 5)。术后随访 6～ 1 4个月 ,除 1例偶发一过性脑缺血发作 (TIA)外 ,其他病人未再出现TIA和新的中风。结论　血管内支架置入术是治疗高危颈内动脉狭窄安全、有效的治疗手段     

彩超观测TIPSS术后门脉血流方向改变的价值

目的:探讨彩超评价经颈静脉肝内门-体分流(TIPSS)术后肝内门脉分支血流动力学变化的价值。方法:62例肝硬化门脉高压患者TIPSS术前后行CDFI检查,动态观测门脉分支血流方向的变化,并结合门脉造影结果分析术后肝内门脉分支血流方向变化的意义。结果:16例患者TIPSS术前门脉主干及分支为离肝血流(离肝血流或双向血流),术后随访门脉血流方向未改变;46例患者TIPSS术前门脉主干及分支为入肝血流者术后即有31例门脉左、右支变为离肝血流,2年内31例中有15例发生支架管狭窄或闭塞,而此时15例患者门脉左、右支血流均又变为入肝血流。结论:彩超是术后随访观察分流道开放情况简便准确的方法。TIPSS术前门脉流向为入肝血流的患者术后肝内脉分支变为离肝血流是支架管通畅的可靠间接证据;若随访中肝内门脉分支离肝血流再次变为入肝血流,则提示支架管功能障碍。彩超观察TIPSS术前后门脉分支血流方向的动态变化,对评定部份患者支架管功能有重要价值。     

跨肾动脉放置覆膜内支架治疗腹主动脉瘤对肾功能的影响

目的 :血管内覆膜内支架放置修补术治疗腹主动脉瘤基本标准是要求近端瘤颈长度 >1 5～ 2 0mm。通过比较术前术后BUN及血清肌酐水平 ,探讨跨肾动脉放置支架对肾功能的影响。方法 :1 3例腹主动脉瘤患者行经腹血管内覆膜内支架修补术 ,支架的裸露部分跨过肾动脉开口放置 ,以利于支架与血管壁附着牢固。术前及术后均检查患者的肾功能。结果 :术前 2例血清BUN异常 ,4例血肌酐浓度异常 ,术前DSA显示有肾动脉狭窄的 2例。术后 1个月 4例出现肾功能异常 ,2例术前BUN正常者出现异常。BUN平均值为 (7.1 7± 3 .92 )mmol/l,与术前比较差异无显著性意义 (P >0 .0 5)。血肌酐浓度平均值为 (1 57.69± 1 80 .2 7) μmol/l,与术前比较差异无显著性意义 (P >0 .0 5)。术后 3个月BUN为(6 .62± 3 .50 )mmol/l,血肌酐浓度为 (1 54 .2 3± 1 75 .49) μmol/l,与术前比较差异亦无显著性意义 (P >0 .0 5)。 结论 :只要支架位置正确 ,支架的开放性“筛孔”可以容许血流顺利进入肾动脉 ,则不会损害肾功能     

103Pd支架预防血管成形术后再狭窄量效关系研究

目的　探讨1 0 3Pd支架对血管成形术后再狭窄预防作用的量效关系及是否导致边缘再狭窄。方法　 5 0只雄性新西兰兔随机分为普通支架组和核素支架各剂量组 (8只 组 )。支架植入术后 8周行腹主动脉血管内超声和造影检查。结果　核素支架组随剂量增加 ,支架段血管最小内径和支架段血管管腔切面积均增大 ,狭窄程度减小 ;核素支架 2 5及 35Gy组支架边缘段血管管腔内增生内膜切面积及外弹力板切面积变化 (缩小值 )均小于普通支架组 (P <0 .0 5 )。结论　1 0 3Pd支架可抑制支架内内膜增生 ,减轻支架内狭窄程度 ,且不引起边缘再狭窄。     

经颈静脉肝内门体静脉内支架分流术术式改良的实验研究

目的：探讨建立改良式猪经颈静脉肝内门体静脉内支架分流术（TIPSS）模型的可行性及其意义。方法：11只家猪分成2组，7只采用改良术式（经肝段下腔静脉穿刺门脉）建立TIPSS模型，另4只行常规TIPSS作对照。共置入4枚进口覆膜镍钛合金支架，8枚国产覆聚氨酯膜支架。其中，改良组7只猪置入7枚支架（4枚进口支架，3枚国产支架）；对照组4只猪置入5枚国产覆膜支架（1只猪置入时支架发生移位，故加用1枚支架）。术后4周（5只），8周（2只）和12周（4只）进行门脉造影观察分流道通畅情况。动物处死后，行分流道大体和组织病理学检查。结果：术后4周，改良组2只分流道通畅（进口支架、国产支架各1枚），分流道表面均形成完整的假性内膜组织；另5只分流道在4至12周均闭塞，分流道内形成血栓，其中2只内支架伸入下腔静脉内不全，陷入肝实质内。常规组4只分流道在4、8和12周观察期内均闭塞。两组间分流道肝（下腔）静脉端，肝实质段和门静脉端各段的增生组织厚度对比差异均无显著性意义（t值分别为0．14、0．16和0．20，P值均＞0．05）。结论：改良式猪TIPSS模型的建立是安全和可行的。改良式TIPSS中应采用覆膜支架，并应有足够长度伸入至两端静脉内，有助于防止增生组织向分流道内长入。     

κB抑制蛋白基因对血管内支架植入术后内膜增生抑制作用的实验研究

目的　观察血管内局部转移腺病毒携带的IκBα基因对兔髂动脉内支架植入术后内膜增生的抑制作用。方法　 12只杂种新西兰大白兔 ,2 4支髂动脉 ,随机 (计算机 )分为转基因组、磷酸盐缓冲液 (PBS)对照组和空白对照组 (各组均为 8支髂动脉 )。转基因组髂动脉于支架植入术后 ,经多隧道球囊导管输送腺病毒携带的IκBα基因行局部转基因治疗 ;PBS对照组于髂动脉支架植入术后 ,局部注射PBS ;空白对照组则仅行髂动脉内支架植入术。分别于术后 1周和 4周 6只兔重复髂动脉造影 ,之后再处死动物 ,取支架植入处动脉作病理检查 ,分近、中、远 3段 ,测量新生内膜截面积等。结果术后 1周和 4周造影显示各组的管腔内径间差异均无显著性意义 (F =0 .0 5 ,2 .71;P >0 0 5 ) ,但术后4周 ,各组新生内膜截面积分别为 (2 2 8± 0 14 )mm2 ,(3 2 6± 0 2 5 )mm2 ,(2 80± 0 2 0 )mm2 ,转基因组明显小于对照组 (F =5 .0 7,P <0 0 5 )。结论　血管内局部转移腺病毒携带的IκBα基因可以抑制兔髂动脉内支架植入术后的内膜增生 ,从而可能降低支架植入术后再狭窄的发生率     

症状性颅外颈动脉狭窄的血管内支架和药物治疗的临床疗效研究

目的　对比分析症状性颅外颈动脉狭窄的血管内支架和单纯药物治疗的疗效 ,评价两种治疗方法的有效性和安全性。方法　 2 0 0 1年到 2 0 0 3年我科门诊及病房治疗的症状性颅外颈动脉狭窄2 6 5例 ,其中支架治疗组 16 0例 ,单纯药物治疗组 10 5例。结果　颈动脉支架成形术 (CAS)手术的技术成功率 10 0 % ,血管狭窄由术前平均 79.5 %± 14 .6 %降至术后平均 11.2 %± 7.8% (P <0 .0 1) ,血管直径由术前 1.5± 0 .6mm恢复至 4 .1± 0 .4mm。治疗 30d内支架组和药物组各有 1例大卒中 (0 .6 3%、0 .95 % ,P >0 .0 5 ) ,药物组死亡 1例 (0 .95 % ) ,支架组无死亡。平均随访 13.5个月 ,支架组无死亡 ,同侧卒中 1例(0 .6 3% ) ,总的卒中和死亡 2例 (1.2 5 % ) ,药物组同侧卒中 4例 (3.81% ) ,死亡 1例 (0 .95 % ) ,总的卒中和死亡 5例 (4 .76 % )。支架组再狭窄 1例 (0 .6 3% ) ,因患者临床没有脑缺血症状 ,未进行再次治疗。结论　颈动脉支架成形术是治疗症状性颅外颈动脉狭窄和预防卒中安全而有效的方法 ,其围手术期总的卒中和死亡率低 ,1年随访卒中复发率和再狭窄率低 ,较单纯药物疗效更好。     

鼓室置管治疗腭裂患者听力障碍的临床观察

目的　探讨伴分泌性中耳炎腭裂患者 ,采用鼓室置管术对中耳功能及听力损失的影响。方法　对 12 0例 ( 2 19耳 )患有分泌性中耳炎的腭裂患者 ,随机分为观察组 :腭裂修复 +鼓室置管术组 ;对照组 :单纯腭裂修复组。术后 6个月进行鼓室图 ,脑干听觉诱发电位检查。结果　中耳置管组术前术后V波反应阈值及轻中度听力损失有显著差异 (t =11 3 2 ,P <0 .0 1;χ2 =3 8 2 8,P <0 .0 0 1)。对照组术前术后V波反应阈值及轻中度听力损失均无显著差异 (t=1 2 4,P >0 .0 5 ;χ2 =2 46,P >0 .0 5 )。术前两组V波反应阈值及轻中度听力损失差异无显著性 (P>0 .0 5 ) ,术后两组V波反应阈值及轻中度听力损失差异有显著性 (t =12 86,P <0 .0 1;χ2 =10 12 ,P <0 .0 0 1)。中耳置管组术前术后鼓室图有显著差异 ( χ2 =40 75 ,P <0 .0 0 1) ;对照组术前术后鼓室图差异无显著性 ( χ2 =1 45 ,P >0 .0 5 )。术前两组鼓室图差异无显著性 ,术后两组鼓室图有显著差异 ( χ2 =2 0 76,P <0 .0 0 1)。结论　腭裂修复同时行鼓室置管有利于伴有分泌性中耳炎腭裂患者中耳功能改善 ,提高患者听力。     

高龄患者弥漫性冠状动脉支架内再狭窄的切割球囊治疗

目的　研究切割球囊成形术 (CBA)治疗高龄患者弥漫性冠状动脉 (冠脉 )支架内再狭窄(ISR)的安全性与疗效。方法　冠脉内支架植入术后复查冠脉造影示ISR >70 %的高龄弥漫性ISR患者117例 ,分为CBA组 (n =74 )和普通球囊成形术 (BA)组 (n =4 3)。于术后 6个月随访冠脉造影 (QCA)和血管腔内超声 (IVUS)。结果　手术成功率CBA组为 99% ,BA组为 10 0 % ;CBA组冠脉管腔的即刻获得大于BA组 ;两组术后即刻管腔直径狭窄百分比 (DS)在CBA组小于BA组 (11.81± 9.17对 2 6 .33±10 .0 4 ,P <0 .0 5 ) ;平均随访时间 (5 .8± 1.6 )个月时CBA组的DS小于BA组 (2 9.4 3%± 12 .16 %对4 6 .12 %± 13.0 1% ,P <0 .0 5 ) ;CBA组复发的ISR病变长度由术前的 (2 3.17± 12 .4 6 )mm缩短至 (11.2 3±5 .6 8)mm ,而BA组手术前后无改变 ,两组差异有显著性 (P <0 .0 5 )。IVUS显示 ,两组术前及术后即刻的MLA、RVA及SA均无显著性差异。结论　CBA治疗高龄患者弥漫性ISR安全、有效 ,其即刻及随访期疗效令人满意 ,复发的ISR病变长度较BA组明显缩短。     

Percutaneous Transjugular Direct Porto-caval Shunt in Patients with Budd-Chiari Syndrome

The purpose of the study was to evaluate the feasibility and effectiveness of direct porto-caval shunts in patients with Budd-Chiari syndrome (BCS) in whom there is no access to the hepatic veins during transjugular intrahepatic portosystemic shunt (TIPSS). We included six consecutive patients with fulminant/acute Budd-Chiari syndrome (mean age: 35 years) in whom a conventional TIPSS was not possible due to inaccessible hepatic veins. We performed a direct porto-caval shunt via a transhepatic approach. Patients were followed up by means of clinical examination, laboratory investigations, and Doppler ultrasound. TIPSS implantation from the inferior vena cava (IVC) was successful in all six patients (100%). The median transhepatic shunt length was 9 cm (8–10 cm). No procedure-related complications were observed in our patients. Early shunt occlusion occurred in three out of six patients (50%). In all three of these patients, the stent used to stabilize the shunt ended 1–2 cm before reaching the IVC. All occlusions were successfully recanalized. One of these patients developed recurrent early shunt as well as mesenteric and splenic vein occlusions. She died 7 days after TIPSS placement due to an unmanageable coagulation disorder. The remaining five patients were followed up by planned clinical examination and laboratory investigations (mean follow-up time was 15 months; patient 1 was followed up for 13 months, patient 2 for 14 months, patient 3 for 15 months, and patients 4 and 5 for 16 months) and all displayed a complete and durable resolution of liver failure and ascites without reintervention. In patients with acute liver failure originating from BCS and inaccessible hepatic veins, a direct transhepatic porto-caval shunt can be performed safely and effectively under ultrasound guidance. Future studies in larger patient groups should investigate if the patency of transcaval TIPSS with long transhepatic shunt segments is similar compared to conventional TIPSS via the hepatic vein.     

Radiologische Nachsorge des transjugulären intrahepatischen Stentshunts (TIPSS)

The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinations essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS. Ultrasound is helpful to detect shunt dysfunction, but nevertheless its failure rate is considerable despite the use of contrast enhancers such as Levovist because of anatomic and physical limitations, particularly when TIPSS-tracts deep in the liver are present. Reintervention rates approach 90-100% after 24 months, with 100% in child's A patients with comparatively good liver function. However, a strict shunt surveillance program with early portography and reintervention when necessary guarantees high clinical success rates associated with very low rebleeding rates below 10%. Overall the secondary success rate is 80%. Secondary failures are mainly caused by lack of patient compliance during follow-up. In a subgroup of patients no shunt maturation is observed, requiring multiple shunt revisions. In cases of recurrent shunt occlusions an association with bile leaks is presumed. In selected cases patients with chronically recurrent shunt stenosis or occlusions may benefit from placement of TIPSS stent grafts.     

Restoration of Liver Function and Portosystemic Pressure Gradient after TIPSS and Late TIPSS Occlusion

TIPSS (transjugular intrahepatic portosystemic shunt) may be indicated to control bleeding from esophageal and gastric varicose veins, to reduce ascites, and to treat patients with Budd-Chiari syndrome and veno-occlusive disease. Numerous measures to improve the safety and methodology of the procedure have helped to increase the technical and clinical success. Follow-up of TIPSS patients has revealed shunt stenosis to occur more often in patients with preserved liver function (Child A, Child B). In addition, the extent of liver cirrhosis is the main factor that determines prognosis in the long term. Little is known about the effects of TIPSS with respect to portosystemic hemodynamics. This report deals with a cirrhotic patient who stopped drinking 7 months prior to admission. He received TIPSS to control ascites and recurrent esophageal bleeding. Two years later remarkable hypertrophy of the left liver lobe and shunt occlusion was observed. The portosystemic pressure gradient dropped from 24 mmHg before TIPSS to 11 mmHg and remained stable after shunt occlusion. The Child's B cirrhosis prior to TIPSS turned into Child's A cirrhosis and remained stable during the follow-up period of 32 months. This indicates that liver function of TIPSS patients may recover due to hypertrophy of the remaining non-cirrhotic liver tissue. In addition the hepatic hemodynamics may return to normal. In conclusion, TIPSS cannot cure cirrhosis but its progress may be halted if the cause can be removed. This may result in a normal portosystemic gradient, leading consequently to shunt occlusion.     

The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): Long-term follow-up of 100 patients

PURPOSE: To retrospectively evaluate results and clinical outcome of transjugular intrahepatic portosystemic shunt (TIPS) after implantation of a polytetrafluoroethylene (PTFE)-covered stent graft. MATERIAL AND METHODS: The stent graft was used in 112 patients with higher risk of primary (i.e. patients with Budd-Chiari syndrome) or secondary shunt failure (patients with occlusion of a previous uncovered stent), or a complicated TIPS procedure with an imminent technical complication requiring covered stent. Patients were scheduled at 3- to 6-month intervals for duplex-sonographic control of shunt function. Radiological revision was performed in patients with a decrease in shunt function by >25%, primary non-response, or relapse of the index symptom. RESULTS: Twelve patients were lost to follow-up, and 100 patients were followed for 22+/-15 months. The actuarial rates of shunt patency were 90, 84, and 74% at 1, 2, and 3 years of follow-up, respectively. Two patients developed early (within 1 month) and 14 patients late shunt failure. Except for one transient rise in liver enzymes due to outflow obstruction by the stent graft, no technical complications were seen. Primary response to treatment was seen in 97% of patients treated for variceal bleeding and 84% of patients treated for refractory ascites. A relapse of the index symptom was seen in 13% of bleeders and 9% of patients treated for refractory ascites. CONCLUSION: TIPS created with a PTFE-covered stent graft showed favorable long-term results.     

TIPSS术后肝性脊髓病（附5例报告）

目的：报告5例经颈静脉途径肝内分流术（TIPSS）后肝性脊髓病（HM）的临床表现。资料和方法：5例均有乙型肝炎和静脉曲张破裂出血病史。TIPSS术前影像学检查显示肝萎缩明显，术后分流道通畅。曾做脊髓MRI4例，1例做脊柱CT和脊髓造影。5例均行腰椎穿刺。结果：5例于TIPSS后4周－4个月出现进行性下肢痉挛性瘫痪，1例伴上肢无力，1例伴有尿失禁。5例术后有1次以上（1－6次）HE发作史。体验发现患者腱反射亢进，踝阵挛阳性，浅感觉正常，1例深感觉减退，除1例外，其余无明显肌莓缩表现。受累节段椎管影像学检查及腰椎穿刺脑脊液检查均无异常。5例均有术后持续高血低蛋白血症。结论：TIPSS术后出现进行性下肢痉挛性瘫痪、不伴有感觉障碍者应考虑HM。与TIPSS相关HM的高危因素有术前明显肝萎缩、术后持续高血氨及肝性脑病。     

经颈静脉肝内门-体静脉分流术应用疗效观察

本文报告经颈静脉肝内门-体静脉分流术(TIPSS)14例,成功12例。术后食道静脉曲张明显减轻乃至消失、门脉主干血流速度显著增加、门脉压力平均下降1.48kPa、血小板有所升高、白细胞变化不大、脾脏体积缩小30-60％。本组临床应用结果表明:TIPSS创伤性小,降低门脉压可靠,是治疗门脉高压症的有效方法;此技术成功的关键是术前了解肝静脉与门静脉的空间关系。     

Viatorr支架在门静脉高压合并上消化道出血的临床应用

目的：观察Viatorr支架在经颈静脉肝内门腔静脉分流术（TIPS）中治疗门静脉高压合并上消化道出血的临床效果。 方法：收集2016年11月至2017年10月我院收治的因门静脉高压合并食管胃底静脉曲张破裂出血患者17例,使用Viatorr支架行TIPS治疗。测量Viatorr支架分流前后门腔静脉压力梯度（PSG）值变化,手术前后肝功能、血氨、凝血酶原时间变化,以及术后支架通畅率与再出血情况,并对临床疗效及并发症情况进行分析。 结果：17例患者均获得100%技术性成功。TIPS术后的PSG为（14.47±3.39）mmHg,比术前的（25.47±5.77）mmHg明显降低,差异有统计学意义（t=12.015,P<0.05）。TIPS术后1 d,血氨较术前有所升高[（55.38 ±9.27）μmol/L vs.（40.60±8.14）μmol/L,P<0.05],而术后1周的血氨较术前没有明显变化[（34.77±5.01）μmol/L vs.（40.60±8.14）μmol/L,P>0.05],手术前后的总胆红素、白蛋白、谷丙转氨酶、谷草转氨酶、凝血酶原时间差异无统计学意义。17例患者中16例存活,1例于术后52 d并发肺部感染致呼吸衰竭死亡;4例患者出现I期或II期肝性脑病,纠正后症状逆转;所有患者至随访结束均未再出现呕血、黑便等症状,所有病例术后1周及3个月后均行腹部彩超或增强CT检查,至随访结束（或死亡前）TIPS分流通道血流通畅,通畅率100%,2例合并腹水患者复查腹水消失。术后1~3个月内4例患者复查胃镜,均提示食管胃底曲张静脉缓解或消失。 结论：TIPS术中使用Viatorr支架能明显降低门静脉压力,维持分流道的长期通畅,降低上消化道再出血率,术后肝性脑病并发率在可控制范围内,是门静脉高压患者的一种安全有效的治疗手段。     

TIPSS治疗肝硬化门脉高压症的术后并发症及护理

目的:探讨经颈静脉肝内门体支架分流术(transjugular intrahepatic portosystemic stent-shunt,Tipss)治疗肝硬化门脉高压症的并发症及护理。方法:对我院50例肝硬化Child-Push分级B、C级患者分别给予Tipss术,术中、术后严密观察病情变化、手术进程及各种并发症的发生情况,并针对不同情况,给予细致的护理观察,总结观察结果。结果:50例患者术后平均门静脉压力下降20cm H2O,术后肝硬化门脉高压患者的腹水或上消化道出血两大并发症得到不同程度的缓解;术后1月内,除1例1周后支架即闭塞,1例术后即并发严重肝性脑病外,未见其他并发症的发生,远期并发症主要以反复的肝性脑病及支架闭塞为主,其他肝静脉闭塞、肝性神经病变较少见;术后1月复查肝功,平均Child积分变化不大。结论:Tipss是治疗肝硬化合并门脉高压症有效方法,术后门脉压力缓解明显,但术后支架狭窄与肝性脑病高发,通过加强护理可降低其发生率,但肝性脑病仍处在较高的水平,是Tipss开展的又一难题。     

TIPSS术治疗门脉高压症11例疗效分析

ＴＩＰＳＳ治疗肝硬化门脉高血压１１例。全组病例均有不同程度的腹水，其中９例在入院前有反复上消化道出血史。手术成功１０例，失败１例，２例于ＴＩＰＳＳ术后１月并发肝性脑病，２例于要后１－５月再次上消化道出血，１例术后腹腔内出血。肝性脑病的原因与分流量大小和术前肝功能状态有关，支架应建立在门静脉主干旁左在分支为宜。本文还介绍了ＴＩＰＳＳ术前准备和术后并发症的预防和治疗。